Hormone therapy (HT) may be safe for use in women aged over 65 years, according to a recent study published in Menopause, the journal of The Menopause Society.
Takeaways
- Recent findings challenge previous concerns about hormone therapy (HT) safety in women aged over 65, indicating potential benefits for managing menopausal symptoms.
- Despite initial worries stemming from the Women's Health Initiative in 2002, subsequent studies have presented conflicting results regarding HT risks.
- The study, based on records from 10 million senior Medicare women, highlights variations in HT outcomes based on factors such as type, route, and dose, supporting the 2022 Position Statement by The Menopause Society.
- The Menopause Society emphasizes that age alone should not deter women from using HT, advocating for continued use with proper counseling and risk assessment, especially for managing symptoms such as hot flashes.
- While some HT formulations, particularly combination estrogen and progesterone therapy, were associated with increased breast cancer risk, others such as low-dose transdermal or vaginal estrogen plus progestin showed potential benefits and risk reduction for various health outcomes.
In 2002, the Women’s Health Initiative (WHI) led to many women avoiding HT because of concerns relating to increased cancer and heart disease risks. These concerns have remained among some health care providers and middle-aged patients despite a WHI follow-up in 2004 and other studies displaying conflicting results.
A common fear among providers and patients is that risks of stroke, invasive breast cancer, and coronary heart disease may increase among patients aged over 65 years taking HT. However, HT is an effective treatment method against symptoms such as hot flashes among menopausal women, and these fears prevent patients from obtaining relief.
Investigators conducted a large-scale study using records from 10 million senior Medicare women between 2007 and 2020. Study results indicated variations in outcomes of HT use based on type, route, and dose among patients aged over 65 years, supporting the 2022 HT Position Statement of The Menopause Society.
In the 2022 HT Position Statement, The Menopause Society stated age alone should not lead to women stopping HT use. Additionally, the statement expressed support for women continuing to use HT for hot flash management with adequate counseling and risk assessment.
Since data about the outcomes of varying HT formulations, doses, and administration routes was lacking, investigators prioritized evaluating the impact of HT in women aged over 65 years based on these factors. The researchers concluded risks of breast cancer, lung cancer, congestive heart failure, and other outcomes are reduced by HT monotherapy in this population.
While combination estrogen and progesterone therapy were associated with increased breast cancer risk, low doses of transdermal or vaginal estrogen plus progestin may be used to reduce the risk. Progestin usage was also associated with significantly reduced endometrial cancer, ovarian cancer, congestive heart failure, ischemic heart disease, and thromboembolism risks.
“This large observational study of women in Medicare provides reassurance regarding the safety of longer-term hormone therapy use and even potential benefits, particularly in women using estrogen alone,” said Stephanie Faubion, MD, MBA, medical director for The Menopause Society.
Reference
Women aged older than 65 years may be able to safely continue taking hormone therapy. The Menopause Society. April 10, 2024. Accessed April 24, 2024. https://www.menopause.org/docs/default-source/press-release/use-of-ht-beyond-age-65-and-its-effects-by-type.pdf
